Provider Demographics
NPI:1578612628
Name:GORR, DONNA J (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:GORR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:MI
Mailing Address - Zip Code:48064-1202
Mailing Address - Country:US
Mailing Address - Phone:586-323-8280
Mailing Address - Fax:
Practice Address - Street 1:50680 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3107
Practice Address - Country:US
Practice Address - Phone:586-323-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist